Abstract：
BACKGROUND: Patients with BRCA-positive metastatic castration-resistant prostate cancer (mCRPC) have an aggressive disease course. This study aimed to describe real-world treatment patterns among patients with BRCA-positive mCRPC.
METHODS: De-identified electronic health record data from the Flatiron Health-Foundation Medicine Inc. Metastatic Prostate Cancer Clinico-Genomic Database (January 01, 2011 to June 30, 2022) were used to select patients with BRCA-positive mCRPC initiating first-line (1L) therapy with an oncologist-defined advanced line of therapy (LOT) or androgen deprivation therapy (ADT) monotherapy. Treatment sequences and reasons for censoring were described in 1L, and among patients who initiated a second-line (2L) therapy.
RESULTS: A total of 98 treated patients with BRCA-positive mCRPC were identified. The top 3 treatment regimens in 1L, overall, were ADT monotherapy (19%), enzalutamide (14%), and olaparib (13%). The main reason for censoring patients with ADT monotherapy was death (52.6%). Among 79 patients treated with an advanced LOT in 1L, 43.0% (n = 34) did not initiate a 2L therapy, of which, 29.4% died. In patients who initiated a 2L (n = 45), the most common 1L to 2L treatment sequence was olaparib to docetaxel (11.1%). The most prescribed 2L therapies were docetaxel (22.2%), olaparib (20.0%), abiraterone acetate (13.3%), and enzalutamide (11.1%). From 1L initiation, the median time-to-next-treatment was 6.2 months.
CONCLUSIONS: Among patients with BRCA-positive mCRPC, ADT monotherapy, enzalutamide, and olaparib were most commonly used. Prognosis of BRCA-positive patients was poor, with most patients failing initial therapy resulting in a switch to a new therapy or death. These findings highlight the need for earlier and more effective treatments for patients with BRCA-positive mCRPC.
METHODS: De-identified electronic health record data from the Flatiron Health-Foundation Medicine Inc. Metastatic Prostate Cancer Clinico-Genomic Database (January 01, 2011 to June 30, 2022) were used to select patients with BRCA-positive mCRPC initiating first-line (1L) therapy with an oncologist-defined advanced line of therapy (LOT) or androgen deprivation therapy (ADT) monotherapy. Treatment sequences and reasons for censoring were described in 1L, and among patients who initiated a second-line (2L) therapy.
RESULTS: A total of 98 treated patients with BRCA-positive mCRPC were identified. The top 3 treatment regimens in 1L, overall, were ADT monotherapy (19%), enzalutamide (14%), and olaparib (13%). The main reason for censoring patients with ADT monotherapy was death (52.6%). Among 79 patients treated with an advanced LOT in 1L, 43.0% (n = 34) did not initiate a 2L therapy, of which, 29.4% died. In patients who initiated a 2L (n = 45), the most common 1L to 2L treatment sequence was olaparib to docetaxel (11.1%). The most prescribed 2L therapies were docetaxel (22.2%), olaparib (20.0%), abiraterone acetate (13.3%), and enzalutamide (11.1%). From 1L initiation, the median time-to-next-treatment was 6.2 months.
CONCLUSIONS: Among patients with BRCA-positive mCRPC, ADT monotherapy, enzalutamide, and olaparib were most commonly used. Prognosis of BRCA-positive patients was poor, with most patients failing initial therapy resulting in a switch to a new therapy or death. These findings highlight the need for earlier and more effective treatments for patients with BRCA-positive mCRPC.
摘要：
背景：BRCA阳性转移性去势抵抗性前列腺癌（mCRPC）患者具有侵袭性病程。这项研究旨在描述BRCA阳性mCRPC患者的真实世界治疗模式。
方法：使用来自FlatironHealth-FoundationMedicineInc.转移性前列腺癌临床基因组数据库（2011年1月1日至2022年6月30日）的去识别电子健康记录数据，选择BRCA阳性mCRPC患者，开始接受肿瘤学家定义的高级治疗（LOT）或雄激素剥夺治疗（ADT）的一线（1L）治疗。1L中描述了治疗顺序和审查原因，以及开始二线（2L）治疗的患者。
结果：共确定了98例BRCA阳性mCRPC患者。1L前3种治疗方案，总的来说,ADT单药治疗（19%），恩扎鲁他胺（14%），和奥拉帕尼(13%)。对ADT单药治疗患者进行审查的主要原因是死亡（52.6％）。在79例接受1L晚期LOT治疗的患者中，43.0%(n=34)没有开始2L治疗，其中，29.4%死亡。在启动2L（n=45）的患者中，最常见的1L~2L治疗顺序是奥拉帕尼~多西他赛(11.1%).处方最多的2L疗法是多西他赛（22.2%），奥拉帕尼（20.0%），醋酸阿比特龙（13.3%），和恩扎鲁他胺(11.1%)。从1L开始，至下一次治疗的中位时间为6.2个月.
结论：在BRCA阳性mCRPC患者中，ADT单药治疗,恩扎鲁他胺,和奥拉帕利是最常用的。BRCA阳性患者预后较差,大多数患者初始治疗失败，导致改用新疗法或死亡。这些发现强调了对BRCA阳性mCRPC患者进行早期和更有效治疗的必要性。
方法：使用来自FlatironHealth-FoundationMedicineInc.转移性前列腺癌临床基因组数据库（2011年1月1日至2022年6月30日）的去识别电子健康记录数据，选择BRCA阳性mCRPC患者，开始接受肿瘤学家定义的高级治疗（LOT）或雄激素剥夺治疗（ADT）的一线（1L）治疗。1L中描述了治疗顺序和审查原因，以及开始二线（2L）治疗的患者。
结果：共确定了98例BRCA阳性mCRPC患者。1L前3种治疗方案，总的来说,ADT单药治疗（19%），恩扎鲁他胺（14%），和奥拉帕尼(13%)。对ADT单药治疗患者进行审查的主要原因是死亡（52.6％）。在79例接受1L晚期LOT治疗的患者中，43.0%(n=34)没有开始2L治疗，其中，29.4%死亡。在启动2L（n=45）的患者中，最常见的1L~2L治疗顺序是奥拉帕尼~多西他赛(11.1%).处方最多的2L疗法是多西他赛（22.2%），奥拉帕尼（20.0%），醋酸阿比特龙（13.3%），和恩扎鲁他胺(11.1%)。从1L开始，至下一次治疗的中位时间为6.2个月.
结论：在BRCA阳性mCRPC患者中，ADT单药治疗,恩扎鲁他胺,和奥拉帕利是最常用的。BRCA阳性患者预后较差,大多数患者初始治疗失败，导致改用新疗法或死亡。这些发现强调了对BRCA阳性mCRPC患者进行早期和更有效治疗的必要性。
